Real-world observational study evaluating metabolic and kidney outcomes in patients living with chronic kidney disease and type 2 diabetes mellitus with obesity prescribed tirzepatide.

BACKGROUND

Obesity and type 2 diabetes mellitus (T2DM) accelerate chronic kidney disease (CKD) progression. Tirzepatide, a dual glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) receptor agonist, has demonstrated metabolic and potential renoprotective benefits in clinical trials. There have been limited reports of the implications of prescribing tirzepatide in a real-world cohort of patients with advanced CKD.

METHODS

This observational study includes a multi-ethnic cohort of 62 adults with CKD stages 1-5 who initiated tirzepatide indicated for T2DM with concurrent obesity in a general nephrology clinic between June 2024 and October 2025. Patients were followed for a median of 21.4 weeks. Clinical outcomes including weight, glycated haemoglobin (HbA1c), estimated glomerular filtration rate (eGFR), urinary albumin-to-creatinine ratio (uACR), blood pressure, lipid profile and insulin requirements were collected.

RESULTS

Tirzepatide significantly reduced median weight (103-100 kg; p < 0.0001), HbA1c (63 [7.9%] to 54 [7.1%] mmol/mol; p = 0.002) and uACR (111-44 mg/mmol; p = 0.008), while eGFR remained stable. Significant improvements were also observed in triglycerides, total cholesterol, LDL cholesterol and total daily insulin dose. Gastrointestinal symptoms and decreased serum bicarbonate were the most common adverse events.

CONCLUSIONS

In this real-world, multi-ethnic cohort, including patients with advanced CKD, tirzepatide was associated with clinically meaningful improvements in weight, glycaemic control, albuminuria, lipid profile and insulin requirements without adversely affecting kidney function. The introduction of tirzepatide to patients with CKD should be guided by a multidisciplinary team.